Latest / The SHEA Podcast / COVID-19: Update In Long Term Care, 9/11

Transcript

COVID-19: Update In Long Term Care, 9/11 · The SHEA Podcast

• 0:10
  SPEAKER_02: Welcome to Rapid Response Podcast brought to you by Society of Healthcare Epidemiology of America, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:28
  SPEAKER_02: I'm Dr.
• 0:28
  SPEAKER_02: Walee Javed.
• 0:29
  SPEAKER_02: I'm the hospital epidemiologist and director of infection prevention and control at Mount Sinai Downtown Network, including Mount Sinai Brooklyn, Mount Sinai Beth Israel, as well as New York I and Ear, and I'll serve as your moderator.
• 0:44
  SPEAKER_02: The discussion on this podcast does not reflect Shay's perspective, but is here to facilitate communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:56
  SPEAKER_02: She is excited to launch today's episode of this podcast, COVID-19 update in the long-term care.
• 1:02
  SPEAKER_02: Our speaker today is Dr.
• 1:04
  SPEAKER_02: Teresa Rowe.
• 1:05
  SPEAKER_02: She's assistant professor of medicine of both general internal medicine as well as GIETICs at Feinberg School of Medicine at Northwestern.
• 1:15
  SPEAKER_02: Thank you so much for joining us.
• 1:16
  SPEAKER_02: I would like to turn it over to Dr.
• 1:18
  SPEAKER_02: Hannahan to get us started with the brief news and guidance update of the week.
• 1:25
  SPEAKER_00: In the news this week, there are as of today 27,688,740 cases of COVID-19 and 899,315 deaths in the world.
• 1:46
  SPEAKER_00: The company announced that a participant experienced an unexplained illness in a UK-based phase three trial, and the trial is on hold while vaccine safety is being assessed.
• 1:56
  SPEAKER_00: The New York Times reported that a trial participant developed transverse myelitis, but it is unknown whether this was related to the vaccine.
• 2:05
  SPEAKER_00: Face fields have been used as part of personal protective equipment and for source control.
• 2:11
  SPEAKER_00: Some people have wanted to use the face fields in place of masks for source control.
• 2:16
  SPEAKER_00: A study published in the Physics of Fluid titled Visualizing Droplet Dispersal for Face Shields and Masks with Exhalation Valves used mannequins with simulated coughs to demonstrate that respirator jets travel around and under face fields quickly following a simulated cough and that the face shields provide no source control.
• 2:35
  SPEAKER_00: The authors also demonstrated that N95 masks with escalation valves allow a continuous stream of droplets with a stimulated cough or sneak.
• 2:45
  SPEAKER_00: One of the questions with SARS-CoV-2 has been whether aerosols from toilets could lead to transmission of infection as occurred with SARS-1.
• 2:53
  SPEAKER_00: A study published in Annals of Internal Medicine on September 1st investigated the temporal and spatial distributions of three infected families in a high-rise apartment building in China.
• 3:05
  SPEAKER_00: The families lived in three vertically aligned apartments connected by drainage pipes in the master bathrooms.
• 3:11
  SPEAKER_00: Both the observed infections and the locations of positive environmental samples were consistent with the vertical spread of virus-laden aerosols via these stacks and vents, and concluded that fecal aerosol transmission may have caused the community outbreak of COVID-19 in this high-rise building.
• 3:29
  SPEAKER_00: And now we turn to the discussion.
• 3:32
  SPEAKER_02: Thank you so much, Dr.
• 3:33
  SPEAKER_02: Hannahan.
• 3:34
  SPEAKER_02: I will now move to discussion with Dr.
• 3:36
  SPEAKER_02: Rowe.
• 3:37
  SPEAKER_02: And I have a few questions for her.
• 3:39
  SPEAKER_02: And thank you again for joining us, Dr.
• 3:41
  SPEAKER_02: Ro.
• 3:42
  SPEAKER_02: So would you mind sharing a little bit about your position with us?
• 3:46
  SPEAKER_01: I am a geriatrician at Northwestern University in Chicago.
• 3:51
  SPEAKER_01: I am also board certified in infectious diseases.
• 3:54
  SPEAKER_01: I work clinically in a long-term care setting in a nursing home and also oversee their infection prevention and control program and policies.
• 4:02
  SPEAKER_01: In addition to that, I also have a role at CDC in the surveillance branch where we work to increase infection surveillance in long-term care.
• 4:13
  SPEAKER_02: Perfect.
• 4:14
  SPEAKER_02: This is an amazing carrier.
• 4:15
  SPEAKER_02: You have multiple specializations.
• 4:18
  SPEAKER_02: Can you tell us a little bit about the realities of COVID-19 on this population, especially the population that you have seen?
• 4:26
  SPEAKER_01: You know, I think that this certainly really obviously hit our older population very hard, and particularly those in long-term care in nursing homes.
• 4:38
  SPEAKER_01: Some of it was not totally unexpected.
• 4:41
  SPEAKER_01: Most respiratory viruses do hit the older population and nursing homes, but this really did seem just on a sort of much greater scale.
• 4:50
  SPEAKER_01: And, you know, it was really devastating for a lot of facilities and a lot of older adults in their families.
• 4:57
  SPEAKER_02: Actually, we saw something very similar in our hospitals that have a lot of nursing home patients that come to those hospitals.
• 5:04
  SPEAKER_02: We saw a lot of elderly who were getting ill.
• 5:07
  SPEAKER_02: So it is a pretty challenging time.
• 5:10
  SPEAKER_01: Yeah.
• 5:11
  SPEAKER_02: What have been the biggest challenges that you have seen?
• 5:15
  SPEAKER_01: So before COVID, many nursing homes struggled with doing respiratory tract infection surveillance or really any kind of infection surveillance, and really probably did not have a lot of resources and staffing for, you know, to really develop a full infection prevention and control policy.
• 5:36
  SPEAKER_01: So then COVID hit, and I think all of those challenges that were already there really came to the forefront.
• 5:42
  SPEAKER_01: And that's why we saw such devastation in many nursing homes.
• 5:46
  SPEAKER_01: The problems were already there, and this just kind of amplified it.
• 5:50
  SPEAKER_01: And so that you know it was really recognized on a national level, some of the challenges that nursing homes face.
• 5:58
  SPEAKER_02: Yeah, I think you're spot on that in terms of the challenges that we're facing.
• 6:02
  SPEAKER_02: And I think hopefully this will bring a lot of challenges pertinent to elderly, pertinent to the nursing home population to the forefront.
• 6:11
  SPEAKER_02: In in terms of successes, what was the biggest success you saw during this time?
• 6:17
  SPEAKER_01: The biggest success is really the success of the frontline staff and all of the healthcare workers in the facilities.
• 6:25
  SPEAKER_01: You know, there's a lot of turnover in nursing homes, and you know, I think this was a time that our frontline staff, those certified nursing assistants, nurses, licensed practical nurses, you know, really stepped up and cared for patients.
• 6:40
  SPEAKER_01: They were on the front line during all of this.
• 6:43
  SPEAKER_01: And so I think, you know, just kind of seeing how that came together was really inspiring.
• 6:49
  SPEAKER_02: You're absolutely correct.
• 6:50
  SPEAKER_02: Our healthcare workers are truly, truly the heroes of this pandemic.
• 6:55
  SPEAKER_02: And I think I'm proud to work with a lot of heroes, and I totally agree.
• 6:59
  SPEAKER_02: Nursing homes and the workers over there, truly remarkable people.
• 7:04
  SPEAKER_02: So thanks for sharing that.
• 7:06
  SPEAKER_02: How have you personally dealt with some of the highs and lows as a physician working with this population for the last few months?
• 7:14
  SPEAKER_01: Yeah, that's a good question.
• 7:16
  SPEAKER_01: I think it has been really challenging.
• 7:18
  SPEAKER_01: You know, I'm in a group of six of the geriatricians, and we go to several different nursing homes in the Chicago area.
• 7:25
  SPEAKER_01: And, you know, I think we saw a variety of responses, and every nursing home was a little bit different.
• 7:32
  SPEAKER_01: And so I think being able to share our experiences with each other was really helpful as a clinician.
• 7:38
  SPEAKER_01: And, you know, I think working with all the frontline staff, and I mean, it was a time where everybody really had to just kind of come together and work hard, and we were really able to do that.
• 7:49
  SPEAKER_01: So that was definitely one of the high points.
• 7:51
  SPEAKER_01: You know, I think dealing with the lows was really challenging.
• 7:54
  SPEAKER_01: I mean, a lot of our patients in residence got very sick, and it was a time when the family members couldn't necessarily always be there.
• 8:02
  SPEAKER_01: So I think talking it through with other clinicians and the staff was really helpful.
• 8:07
  SPEAKER_02: How are you preparing this population for the fall season and what are your concerns?
• 8:13
  SPEAKER_01: There's still a lot of uncertainty in many areas of the country with respect to COVID, and that's only going to be amplified when flu season starts.
• 8:23
  SPEAKER_01: So certainly we are doing our best to make sure that all of our residents and healthcare workers are getting their flu vaccination.
• 8:32
  SPEAKER_01: I think again, the COVID or the pandemic really prompted nursing homes to implement respiratory tract infection surveillance.
• 8:40
  SPEAKER_01: And so, you know, I think many facilities were able to put that into play and are using able to do more active monitoring now, which is I think going to be really helpful.
• 8:51
  SPEAKER_01: The concerns that I think even before COVID are still there, right?
• 8:54
  SPEAKER_01: It goes back to staffing and then starting flu season, you know, are we gonna see respiratory tract infection outbreaks are already very common in nursing homes, not just from flu, but from human metanumovirus and RSV.
• 9:07
  SPEAKER_01: So when you bring that into the mix, I think it could see a big spike in other respiratory tract infections as well.
• 9:13
  SPEAKER_02: That is quite true.
• 9:15
  SPEAKER_02: The upcoming fall season, I think, is uh something that we all need to be mentally ready and prepared to deal with, especially in a nursing home where these challenges can be amplified.
• 9:28
  SPEAKER_02: So, how are you suggesting older patients deal with some of the emotional challenges of social distancing?
• 9:36
  SPEAKER_01: And I think this is probably one of the hardest parts, too, especially those older residents who really relied on a certain caregiver or family member.
• 9:46
  SPEAKER_01: And you know, taking that away from them really disrupted their schedule.
• 9:51
  SPEAKER_01: We did some creative things, try to do a lot of FaceTime when we could have a protected iPad for our patients so they could FaceTime their loved ones.
• 10:01
  SPEAKER_01: We did things for patients who are a little bit like an assisted living.
• 10:05
  SPEAKER_01: We would one time we even put like dog treats outside, and so we had residents like look out the window and watch the dogs and people walk by and eat the dog treats.
• 10:14
  SPEAKER_01: So that was pretty fun to try to think of like creative ways to get people where they could still stay socially isolated, but to get them, you know, looking out the windows and doing having some interaction.
• 10:27
  SPEAKER_01: We definitely had to get creative.
• 10:29
  SPEAKER_02: Really amazed by your approach.
• 10:31
  SPEAKER_02: It's it's something that we we all try to do.
• 10:33
  SPEAKER_02: But Ian, thanks so much for sharing doing the doc treats.
• 10:37
  SPEAKER_02: It's fun as a society.
• 10:39
  SPEAKER_02: How can we best support our older family members through the next few months?
• 10:44
  SPEAKER_01: Stay in touch by phone and to check on family members either via telephone or Skype.
• 10:51
  SPEAKER_01: Again, we found that many older adults can use FaceTime pretty easily.
• 10:55
  SPEAKER_01: So I think checking in on their well-being and also asking about, you know, whether or not medications need to be dropped off or whether or not there's any issues with food, I think are critical.
• 11:05
  SPEAKER_02: That's a that's a brilliant, brilliant idea.
• 11:07
  SPEAKER_02: I think there needs to be a balance between how we manage the visitors or lag thereof and uh the communications and then social isolation that comes with social distancing.
• 11:19
  SPEAKER_02: So I think that you're really hitting it on the important points that we we need to keep them engaged in this conversation.
• 11:27
  SPEAKER_02: That's that's very helpful.
• 11:29
  SPEAKER_02: What do you see as the main areas of research that would really be helpful for this population related to COVID-19?
• 11:37
  SPEAKER_01: Yeah, I think there's a couple of things.
• 11:39
  SPEAKER_01: I think a big area of research is how do we best do infection surveillance in nursing homes?
• 11:45
  SPEAKER_01: And I think there's been a lot of work done in the hospital, and we know a lot more about how this is done in the hospital and in other settings, but at what is the best approach?
• 11:53
  SPEAKER_01: It's gotta be different than in hospitals.
• 11:56
  SPEAKER_01: So, what is the best approach for doing infection surveillance in nursing homes?
• 12:00
  SPEAKER_01: And I also think that one big challenge in nursing homes is sort of identifying when a resident has a change in condition, because that can also sort of signify that there's something going on.
• 12:13
  SPEAKER_01: Sometimes it's an infection, and sometimes that infection leads to sepsis or something else.
• 12:18
  SPEAKER_01: But it all starts often with a resident that has some kind of change in condition.
• 12:22
  SPEAKER_01: And so, how do we better do a more objective assessment of a change in condition instead of this sort of black box of altered mental status or they don't feel well?
• 12:31
  SPEAKER_01: Is there a way that we can really objectively look at a change in condition and make sure that those residents that do in fact have a change in condition are seen or the you know frontline staff is communicating with the clinical team?
• 12:46
  SPEAKER_02: Thank you so much, and thank you so much to our speaker, Dr.
• 12:50
  SPEAKER_02: Roe, for sharing your perspective and experiences and a sincere thank you from Shea to all healthcare personnel for all that you're doing to respond to COVID-19.
• 13:01
  SPEAKER_02: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 13:10
  SPEAKER_02: You will also find resources such as recorded webinars, healthcare facility outbreak preparedness, and the SHA COVID-19 town halls.
• 13:19
  SPEAKER_02: Additional resources are available on Learning CE pertinent to this pandemic, include SHA CDC Outbreak Response Training Program, ORTP, the prevention course in HAI Knowledge and Control.
• 13:34
  SPEAKER_02: You can now receive 75% off SHA membership for the remainder of 2020 using this coupon code podcast during checkout.
• 13:46
  SPEAKER_02: That concludes this episode of Rapid Response Podcast.
• 13:50
  SPEAKER_02: Thank you so much for tuning in.